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Published on: August 12, 2020
Prediction Models for Serious Bacterial Infection in Infants Up to 90 Days of Age
Halima Dabaja-Younis1,2, Nadeen Makhoul3, Rozeen Abu Shqara3
1Pediatric Infectious Diseases Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel.
Insights
A new score helps predict serious bacterial infections (SBIs) in infants under 90 days. The NeoSBIscore uses clinical factors and biomarkers to accurately assess SBI risk in newborns and older infants.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Prediction Models
Background:
- Serious bacterial infections (SBIs) pose a significant risk to febrile infants.
- Accurate risk stratification is crucial for appropriate management and reducing unnecessary antibiotic use.
- Existing predictive models may lack comprehensive clinical data or widely available biomarkers.
Purpose of the Study:
- To develop and validate predictive models for SBIs in febrile infants younger than 90 days.
- To identify key clinical and laboratory risk factors associated with SBIs in different infant age groups.
- To create a practical scoring system for SBI risk assessment.
Main Methods:
- Retrospective study of 1250 febrile infants (<90 days) at a tertiary care center over ten years.
- Analysis of demographic, clinical, and laboratory data, including absolute neutrophil count (ANC) and C-reactive protein (CRP).
- Development of the "NeoSBIscore" incorporating identified risk and protective factors.
Main Results:
- SBIs occurred in 18.4% of infants <29 days and 15.1% of infants aged 29-89 days.
- Elevated ANC and CRP were significant risk factors in both age groups.
- The NeoSBIscore demonstrated high sensitivity (92.8-94.7%) and negative predictive value (94.7-97.0%) for SBI detection.
Conclusions:
- The NeoSBIscore effectively predicts serious bacterial infections in febrile infants.
- The score integrates readily available biomarkers and clinical signs for improved risk assessment.
- This tool can aid clinicians in managing febrile infants and guiding diagnostic decisions.
Abstract:
In a decade-long retrospective study at a tertiary center, predictive models for serious bacterial infections (SBIs) in febrile infants <90 days were devised. Among 1250 infants, SBIs were found in 18.4% of those <29 days and 15.1% of those aged 29 to 89 days. Elevated absolute neutrophil count (ANC) (>7500 mm3) and C-reactive protein (CRP) (>3 mg/dL) were risk factors in both groups, with viral-like illness in family members being protective. Diarrhea was a risk factor in the younger group and protective in the older group, while female sex was a risk factor in the older group. The "NeoSBIscore," incorporating these factors with signs of focal infection and abnormal urinalysis, exhibited 94.7% sensitivity and 97.0% negative predictive value (NPV) in <29 days and 92.8% sensitivity and 94.7% NPV in older infants, effectively detecting SBI with higher thresholds of widely available biomarkers and comprehensive clinical details. This tool aids in SBI risk assessment.
